Li Sijia, Wu Lei, Li Ning, Zhao Xingquan
Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4 Ring West Road, Beijing, 100070, Fengtai District, China.
China National Clinical Research Center for Neurological Diseases, No.119 South 4 Ring West Road, Beijing, 100070, Fengtai District, China.
Transl Stroke Res. 2025 Jan 7. doi: 10.1007/s12975-024-01323-z.
Microcirculatory dysfunction is an important pathophysiology mechanism of early brain injury after aneurysmal subarachnoid hemorrhage (aSAH), which contributes to poor outcomes. The study was performed in Beijing Tiantan Hospital from October 2020 to July 2023. Patients with aSAH who underwent computed tomographic perfusion (CTP) within 24 h after ictus were enrolled prospectively. The peak time of arterial inflow (PTA), peak time of venous outflow (PTV), total venous outflow time (TVT), and difference value of arteriovenous peak time (DV) were collected from the time-density curve of CTP. Primary outcome was 3-month unfavorable functional outcome (modified Rankin Scale score of 4-6). Secondary outcomes included 3-month all-cause death and delayed cerebral ischemia. Multivariable logistic regression analysis and restricted cubic splines were performed to explore the relationship between cerebral hemodynamic parameters and outcomes. We also assessed the prognostic performance of incorporating hemodynamic parameters into previous nomogram models for 3-month poor clinical outcomes. A total of 612 patients were enrolled, among whom the mean age was 56.9 ± 12.3 years old and 391 (63.9%) were female. On multivariable analysis, prolonged TVT could significantly predict 3-month poor functional outcome (adjusted OR 1.074, 95%CI 1.013-1.139), while prolonged PTA was an independent predictor of 3-month all-cause death (adjusted OR 1.293, 95%CI 1.099-1.521). The addition of TVT or PTA to previous nomogram models led to improvements in C-statistics, net reclassification (NRI), and integrated discrimination improvement (IDI). Our study underscores the vital role of arterial inflow and venous outflow in sustaining microcirculation during the acute phase after aSAH, thereby offering new directions for future investigations into therapeutic targets.
微循环功能障碍是动脉瘤性蛛网膜下腔出血(aSAH)后早期脑损伤的重要病理生理机制,与不良预后相关。本研究于2020年10月至2023年7月在北京天坛医院进行。前瞻性纳入发病后24小时内接受计算机断层扫描灌注(CTP)的aSAH患者。从CTP的时间-密度曲线中收集动脉流入峰值时间(PTA)、静脉流出峰值时间(PTV)、总静脉流出时间(TVT)以及动静脉峰值时间差值(DV)。主要结局为3个月时功能预后不良(改良Rankin量表评分为4 - 6分)。次要结局包括3个月时全因死亡和迟发性脑缺血。进行多变量逻辑回归分析和限制性立方样条分析以探讨脑血流动力学参数与结局之间的关系。我们还评估了将血流动力学参数纳入先前用于预测3个月不良临床结局的列线图模型中的预后性能。共纳入612例患者,其中平均年龄为56.9±12.3岁,女性391例(63.9%)。多变量分析显示,延长的TVT可显著预测3个月时功能预后不良(调整后的OR为1.074,95%CI为1.013 - 1.139),而延长的PTA是3个月时全因死亡的独立预测因素(调整后的OR为1.293,95%CI为1.099 - 1.521)。将TVT或PTA添加到先前的列线图模型中可提高C统计量、净重新分类(NRI)和综合判别改善(IDI)。我们的研究强调了aSAH急性期动脉流入和静脉流出在维持微循环中的重要作用,从而为未来治疗靶点的研究提供了新方向。